Provider Demographics
NPI:1063992345
Name:PSYCHOTHERAPY LCSW PC
Entity type:Organization
Organization Name:PSYCHOTHERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADALGIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-680-7023
Mailing Address - Street 1:9029 218TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1336
Mailing Address - Country:US
Mailing Address - Phone:347-680-7023
Mailing Address - Fax:718-454-5027
Practice Address - Street 1:9029 218TH PL
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1336
Practice Address - Country:US
Practice Address - Phone:347-682-7023
Practice Address - Fax:718-454-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty